Consensus non-invasieve diagnostiek van perifere arteriele vaatziekte

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Diaphragm-like membrane causing common femoral vein obstruction: Case report

A 23-year-old woman had exercise-induced right leg symptoms. An extensive diagnostic workup including 2 surgical explorations was performed, but did not reveal the cause. Finally, high-resolution color-coded duplex scanning was performed, which demonstrated an isolated, nonthrombotic obstruction of the common femoral vein by a diaphragm-like membrane. Successful operative repair was accomplished with venotomy and excision of the membrane, with full relief from clinical signs and symptoms at 9-month follow-up

Usefulness and applicability of femorofemoral crossover bypass grafting.

We examined the usefulness of femorofemoral crossover bypass grafting ( FFC) and factors influencing its outcome by retrospectively analyzing all FFCs performed in our hospital over a 5-year period, focusing on both patency rates and clinical efficacy. For 95 patients Kaplan- Meier patency rates were calculated ( follow- up 40.4 +/- 3.0 months). Clinical outcome was defined according to Rutherford's standardized categories. The influence of cardiovascular risk factors and technical characteristics on outcome was determined. Clinical status of the limb remained improved in 89%. One- and 5- year primary, primary assisted, and secondary patency rates were 88.2% and 57.3%, 90.6% and 62.4%, and 92.6% and 68.1%, respectively. Clinical outcome of the limb was better in patients with <50% stenosis in the femoral arteries preoperatively (p = 0.033). No predictors for patency rates were identified. FFCs are effective in the medium long term for patients in all age categories independently of cardiovascular risk factors. The best predictor of clinical outcome is the preoperative degree of stenosis, with a better outcome for patients affected by <50% stenosis. Success of FFC cannot be reliably measured by graft patency alone but should be assessed by combining patency rates and clinical outcome according to standardized categories

Peripheral vascular tree stenoses: evaluation with moving-bed infusion-tracking MR angiography.

Department of Diagnostic Radiology, University Hospital Maastricht, Limburg, The Netherlands. [email protected] PURPOSE: To evaluate a magnetic resonance (MR) angiographic technique for imaging of the peripheral arteries with gadolinium enhancement. MATERIALS AND METHODS: Moving-bed infusion-tracking MR angiograms were obtained in 15 healthy volunteers and in 28 patients with intermittent claudication before and during slow infusion of contrast material. Lower- and upper-leg and pelvic regions were imaged. Unenhanced images were subtracted from gadolinium-enhanced images, and maximum intensity projection images were generated. Image quality was evaluated subjectively and objectively, and maximum intensity projection images were compared with conventional angiograms, which served as the standard of reference. RESULTS: Moving-bed infusion-tracking MR angiography proved to be a robust technique, and image quality on maximum intensity projection images was comparable with that on conventional angiograms. Sensitivity and specificity for grading hemodynamically significant stenoses were 93% and 98%, respectively, with excellent interobserver agreement. CONCLUSION: Moving-bed infusion-tracking MR angiography can be used to image all peripheral arteries in 4 minutes by using a small amount of contrast material and a conventional 1.5-T MR imager

Endothelin-1 levels and conduit artery mechanical properties in end-stage renal disease

BACKGROUND: Endothelial cell (EC) dysfunction markers are increased in end-stage renal disease (ESRD). The present study focused on the relationship between EC markers, conduit artery wall mechanics and hemodynamics in ESRD. METHODS: In 29 ESRD patients and 16 controls, brachial artery diameter, distension, and wall thickness was measured and circumferential wall stress (CWS) calculated. Shear stress was determined with a shear rate-estimating system. Furthermore, von Willebrand factor antigen (vWF) and endothelin-1 (ET-1) levels were measured. RESULTS: vWF (p = 0.002) and ET-1 (p &lt; 0.001) were higher in ESRD patients and vWF was related to ET-1 (r = 0.70, p = 0.005). Peak (p = 0.001) and mean shear stress (p = 0.003) were significantly lower in ESRD patients, and ET-1 showed an inverse log linear relation with both (peak: r = -0.59, p = 0.016; mean: r = -0.64, p = 0.007). Also, ET-1 was log linearly related to CWS (r = 0.58, p = 0.014). CONCLUSION: These results indicate that, in ESRD, conduit artery shear stress is lower, which might be secondary to an increased peripheral vascular resistance caused by higher ET-1 levels